Detour from Normal (3 page)

A short time later, a lanky Indian man in a white lab coat got behind my wheelchair and quickly began to push me out of the area. I was surprised that he didn't wait for patient transport. "Hi, Ken. I'm Dr. Chandra; I'm an ER doctor. I've got to get you to a CAT scan right away so we can see what's happening inside you. Hang in there. It will just take a few minutes." I cringed at that. It seemed that everything in the ER was only going to take a few minutes.

Once we arrived at the CAT scanner, I was unable to do anything but writhe around on the table in pain. It was impossible to hold still long enough to complete the scan. After nearly twenty minutes, the morphine finally took effect. I relaxed and they were able to complete the scan. Afterward the doctor helped me off the table and back into the wheelchair.

"We should have some results shortly," he said and wheeled me back to the ER.

"Where is he? Where's my husband?" I heard Beth yell from the entrance oftheER.

"Hi, Beth," I yelled weakly.

She saw me and ran to my side. "Are you OK?"

"I'm better. They gave me some morphine and it just kicked in. I was in horrific pain before that—the worst I've ever felt. They took me back to have a CAT scan, but I haven't gotten the results yet."

"Does anyone know what's going on?"

"I don't think so. No one's said anything."

A few minutes later, Dr. Chandra returned. "Are you Ken's wife?"

"Yes, I'm Beth."

"I'm Dr. Chandra, the ER doctor. I've looked at Ken's CAT scan, and it looks like he's got diverticulitis. There's a micro-perforation on his sigmoid colon, which has allowed a gas bubble to form outside of his colon. That micro-perforation is what's causing all the pain. In addition, his colon is most likely infected."

"Is it serious? What can you do?" Beth asked.

"The best course of action is to treat it with IV antibiotics and see if we can stop the infection. If we can, he could potentially go home and might only have to make some dietary changes to prevent future infections."

That was a relief to hear. I'd just have to relax in bed for a few days, recover, and get back to normal life. I was glad it wasn't anything life threatening, although based on the severity of the pain, I was inclined to differ with the doctor's optimistic prognosis.

I couldn't stay in the ER forever, so they wheeled me to room 247 in the southwest wing of Desert Hope. Luckily, I was given a private room where I could suffer in solitude. For the moment the pain was manageable with regular half doses of morphine, which made me feel somewhat nauseous. I was glad I'd opted for the half doses or I'd probably have been vomiting and making things really complicated.

A nurse wheeled an IV cart into my room with two IV pumps attached to it. Each pump managed dosages of two different medications. One pump was for saline, a saltwater solution I would receive to ensure that I remained properly hydrated and that my electrolytes stayed in balance. The other pump was for Levaquin and Flagyl, two powerful antibiotics that would kill the infection. The nurse hung the bags of saline, Levaquin, and Flagyl on the hooks on the top tree of the rack. Each of the three bags of chemicals had a small drip chamber to monitor flow rate and to prevent air from entering my blood and causing a deadly embolism. The nurse placed a PIV (peripheral intravenous catheter) into a vein on the inside of my left forearm, through which my medications would be administered. After everything was connected to my single IV line, the nurse adjusted the individual flow rates on each pump, ensuring that all the drip chambers indicated good flow, and then left.

I napped fitfully through much of that afternoon. In the evening I turned on the television to see if there were any shows or movies to watch. I found that I needed to view several mandatory videos before I could watch anything else. The videos painted Desert Hope as a premier state-of-the-art medical facility, and covered the general rules and regulations related to my stay. What interested me most was the description of the pain chart. The pain chart had ten round black-and-white cartoon faces with the leftmost having a beaming smile and the rightmost having a horrified frown with tears squirting from its eyes. Beneath the faces were the numbers one to ten from left to right. The purpose of the chart was to help people better explain their pain to the hospital staff. The number ten was supposed to be like getting your arm cut off with no anesthesia. I couldn't imagine how excruciating that would be. Based on the chart, I figured the pain I'd had was bad but not like getting my arm cut off, perhaps an eight or eight-and-a-half tops.

After watching the videos, I had to complete a quiz on them and pass 100 percent. I imagine that if I couldn't pass, a nurse would have helped me. After passing the quiz, I was exhausted. I turned off the television and room lights and continued my fitful tossing and turning through the night.

The next day, April 15, I lay in bed watching movies and resting. Everything was looking positive. My white blood cell count was around 10.3, which was within the normal healthy range of 4.3 to 10.8. It was a good indication that my infection was under control. My pain had subsided and there was talk of sending me home in a day or so.

April 16 started out uneventfully, but as the day progressed, I felt more and more uncomfortable. By early afternoon, my original pain had quickly returned in its full glory, and a new pain suddenly sent
fire across my abdomen, groin, and upper legs. This new pain was so intense that I had to hold my bedsheets away from my skin. The combined pains were the worst imaginable—without a doubt a ten. I could imagine nothing worse. Pain consumed me; I could think of nothing else and could do nothing else but fight it—not even call for help. So there I sat, alone in my agony, grimacing, yelling through my teeth, and holding the sheets away from my body.

In the middle of this episode, a nurse opened the room door, took one look at me, and rushed for more morphine. After twenty more minutes of intense suffering, the morphine took hold and things settled down. A short time later I was rushed down for another CAT scan to see what was going on. I got on the machine with a little less effort than before, but I could feel a pressure in my abdomen, a warning of worse yet to come.

The CAT scan showed more damage. I'd exacerbated the perforation with all the grimacing, yelling, and contractions of my abdominal muscles. The bubble on my colon had grown. No one could explain the new pain. I requested my doctor but could only see a hospitalist. Thankfully, he arrived quickly. He was a tall Asian man with gold wire framed glasses, sharply dressed in black slacks, a white shirt, and a black tie. He had an air of professionalism about him.

"Hello, Mr. Dickson, I'm Dr. Hou. Tell me a little about what's been going on." I told him everything I could about the first pain, the first CAT scan, the burning, and the second CAT scan. He said "hmm" a lot but didn't relate anything helpful. When he left, I felt no more encouraged than when he'd arrived.

After a few hours had passed, I sensed the start of pain again as the morphine waned. I braced myself for what I expected would be the
worst pain imaginable when another doctor came in. He seemed the polar opposite of Dr. Hou right from the start. He was perhaps forty-eight years old and of Indian descent. He was stocky and around five foot seven. He wore a colorful reddish-brown print shirt with an open collar, no tie, and dark brown casual pants. His most endearing quality was his jolly, straightforward demeanor.

"Hi, Ken, I'm Dr. Bonjani. I'm a hospitalist working with Dr. Hou." He extended his hand, and I shook it as firmly as I could manage. "Dr. Hou and I have conferred about your condition, particularly the new pain you are experiencing."

"Have you figured out what it is?"

"Yes, your prostate is irritated in reaction to everything going on and is so swollen that it has squeezed your urinary tract closed. Consequently, your bladder is about ready to burst. When was the last time you peed?"

"Uh, I don't really remember. It's certainly been days since I've been able to pee. I just assumed I was dehydrated. Why does it hurt so much? I've never felt such intense pain in my life."

"When I said your bladder was ready to burst, what I should have said is that it can't hold one more drop of pee. Ken, you're going to have to man up and get that pee out, or I'll have to put a catheter in. Do you know what that is?"

"Isn't it just a tube you put inside me?"

"Yes, but more to the point, someone has to take hold of your penis in one hand and force a tube up into it with the other—all the way into your bladder." As he explained, he gestured vividly, leaving nothing to the imagination. "Once it's in, they'll inflate a bulb with saline solution so it won't slide out of your bladder. You'll be stuck with that tube hanging out of your penis and a Foley bag full of pee that you have to lug
around with you wherever you go until I tell someone to take it out. Is that what you want?" he asked sternly.

"Since you put it that way, no. I'll try to pee. Can I just use a potty so I don't have to deal with all these tubes and the IV rack going to the bathroom?" I asked, pointing to all the IV tubes connected to me.

"Sure." With that, Dr. Bonjani fetched the potty from the bathroom and placed it beside my bed. "OK, let's see how manly you are. I want you to fill that potty to the rim."

"OK," I said doubtfully.

Carefully I disentangled all my tubes from the IV rack and made my way to the potty. Since the slit in my gown was in the back and I didn't want to expose my naked bum to the nice doctor, I stood by the potty, carefully lifted only the front of the gown, and gave it my best shot. I grunted and groaned; I pressed in different areas of my abdomen with my free hand and stretched my body in different directions.

"Come on, you can do it. Don't be a wuss. Get that pee out!" cheered Dr. Bonjani.

I'd never had a pee cheerleader before. Perhaps my mom had cheered for me when I was young, but if she had, she never told me about it. Having Dr. Bonjani cheer me on didn't exactly put me in the optimum frame of mind to accomplish the job at hand. I was in limbo somewhere between embarrassment and laughter. After trying everything I could while standing up, I sat down, thinking that perhaps I might be more relaxed in that position.

"What? That's a sissy way for a man to pee, but I'll give you a break. Go Ken, go Ken, you can do it, yes you can," Dr. Bonjani chanted, clapping in time.

I forgot all about being embarrassed at that point. Perhaps that had been Dr. Bonjani's intention all along. I cooperated fully as he tried
every "man" trick he could to convince me that I had it in me to defeat whatever was preventing me from peeing. Ultimately it just didn't happen. In exasperation I finally said, "Put the catheter in, please."

"OK, I'll get the nurse to do it in a while. I still think you could have done it though."

"Dr. Bonjani, since you're here, can you explain what's wrong with me? I don't understand what happened. What's diverticulitis?"

"Certainly. When the food you eat moves through your intestines, it's very wet so it moves readily, and, thus, nutrients can more easily be absorbed by the intestines. Once the food has all been digested, all that's left is a kind of soggy waste. Your colon is the last stop before you have a bowel movement. To conserve water in your body, your colon squeezes excess water out of the waste—kind of like wringing water out of a washrag—then recycles it.

"If you ate enough fiber and drank plenty of fluids, your waste would be like chopped, cooked spinach. In Arizona, people tend not to drink enough water and are often dehydrated. In addition, Americans in general don't eat enough fiber. Your waste was probably more like sticky bread dough. The chopped spinach would move easily through, and your colon wouldn't have to work at all. The bread dough on the other hand would stick to everything and is difficult to push through. So, being unable to move it readily, your colon has to expand to make room as it piles up."

As Dr. Bonjani spoke, I realized that as an engineer, I spent a lot of time in laboratories and clean room environments where I wasn't allowed to have a water bottle. In addition, whenever I was in those places, I tended to be very focused on what I was doing and could go for hours without a break, and consequently without anything to drink. I
wondered,
Is that the sole cause of my problem?
I also wondered if there would still be a place for the finer things in life, like donuts, when I got through this, or if I was going to have to spend the rest of my life downing bran cereal and vegetables instead.

"Your colon is like a mesh of muscle fibers that can expand a great deal." Dr. Bonjani placed the fingers of one hand over those of his other at a right angle then spread his fingers to show how the colon can expand in a sort of web fashion. "With the spinach, the mesh is tight and there are no issues. With the bread dough, the mesh expands. As the muscle fibers contract to squeeze out the water and move the waste, the tissue between them balloons out. Over time permanent pockets called 'diverticula' form. This condition is called diverticulosis."